Hyperventilation Leading to Transient T-wave Inversion Mimicking Unstable Angina

Abstract

T-wave inversion in ECG is very frequent and concerning finding as it is often associated with life-threatening conditions. There are numerous conditions mentioned in the literature for transient T-wave inversion such as acute coronary syndrome, cardiac memory T-wave, subarachnoid hemorrhage, electroconvulsive therapy, hyperventilation and indeterminate origin. Hyperventilation is already known as a cause of transient T-wave inversion; however, it is often forgotten in modern clinical settings. A 33-year-old doctor working in the same hospital reported to the emergency department during working hours with a history of acute onset breathing difficulties and atypical chest pain involving the retrosternal region. Arterial blood gas analysis (ABG) findings of respiratory alkalosis with transient T-wave inversion, which normalized soon after normal breathing and reassurance along with normal cardiac workup helped us to reach the correct diagnosis of hyperventilation syndrome.